Addressing overdose risk among recently incarcerated people living with HIV

Introduction As the opioid overdose crisis enters its third decade, certain groups are disproportionately impacted. Some, such as those exiting incarceration and people living with HIV (PLWH), have always been at increased risk for a fatal opioid overdose. Others, such as those who use non-opioids, may be newly at risk due to fentanyl contamination of non-opioid street drugs. There is an urgent need to provide overdose education and naloxone distribution (OEND) and other harm reduction interventions to these groups; however, little is known about risk reduction needs specific to these groups. Methods OEND trainings were given to incarcerated PLWH inside the Philadelphia Department of Prisons. Qualitative interviews about OEND training, overdose experiences, and other harm reduction behaviors were conducted with formerly incarcerated PLWH who used illegal drugs before and after their most recent incarceration. Results OEND trainings were given to 120 incarcerated PLWH and 18 PLWH with a history of incarceration participated in qualitative interviews about OEND training experiences; analysis of needs specific to people who use non-opioids was conducted with the 15 of 18 qualitative participants who used non-opioids. Incarcerated people who received OEND training demonstrated improved overdose knowledge and attitudes about managing a witnessed overdose. Most participants had witnessed overdoses before and after their most recent incarceration and cited altruism as a motive for receiving OEND training and for helping other people. These same participants, however, expressed concern that assisting during an overdose may jeopardize their liberty due to potential interaction with law enforcement. OEND trainings as delivered did not appear to adequately heighten participant concerns about their own potential for experiencing an opioid overdose. This was especially true among those who use non-opioid drugs, despite knowing that the drug market was shifting and there was potential for non-opioid drugs to be contaminated with fentanyl. These same participants believed they would have difficulty recognizing an overdose in someone they perceived as using only non-opioids. All qualitative participants indicated a willingness to use harm reduction techniques to stay safer when using drugs, including a willingness on the part of people who use non-opioids to utilize fentanyl test strips. Conclusion Addressing overdose risk among people who are being released from correctional facilities is a complex process that involves a targeted approach to fully address the unique needs of this population. OEND trainings in correctional settings are feasible and acceptable for incarcerated people. However, formerly incarcerated people have concerns related to assisting in an overdose due to a desire to avoid contact with law enforcement. OEND trainings should address these needs.